DEPARTMENT OF HEALTH AND HUMAN SERVICES
Meeting of: Secretary's Council on National Health Promotion and Disease Prevention Objectives for 2010
September 12, 2000, Proceedings

(2:20 p.m.)

Paul Nannis/HRSA (Moderator)
Rose Marie Robertson, American Heart Association
Mimi Kiser, Interfaith Health Program

DR. SATCHER: Our next topic is also a very important one. It's the use and support of 2010 objectives by schools and civic, volunteer and faith-based organizations. This is a very rich topic for us, just as the previous topic was. We have had a great discussion so far, but this is also a very important one.

I want to welcome everybody back. I hope you are refreshed. I am asking Paul Nannis to moderate this panel. Paul is Director of the Office of Planning, Evaluation and Research in the Health Resources and Services Administration. He has also had some really rich experiences at the local and state level. So, Paul -

Paul Nannis/HRSA (Moderator)

MR. NANNIS: Thank you, Dr. Satcher.

I thought I would start and tell just a brief personal anecdote of how and why Healthy People has been important to me this week. I was trying to clean the gutters on my house this weekend, and I fell off the ladder, splintering a little bone in my ankle, which I thought I could, of course, go without doing anything about; it would heal. I turned out, of course, to be wrong about that.

But when I called Earl, my boss Dr. Fox, and told him I couldn't make it to a meeting Monday because I was going to go see the doctor, Earl suggested that the next time I do that, I pull out my driver's license, look at the year I was born, and remember I'm too old to do those things. So Healthy People is with us all the time.

I'm sorry to say that Michael Thompson, who is the Assistant Superintendent from Wisconsin's Department of Public Instruction, is not going to be with us. He had a death in the family yesterday and called just last night to say he wouldn't be able to come. So we're going to have two speakers. Then I would like to talk just for a minute about my experience in Wisconsin in Healthy People and the relation to it of the schools. Even though it's a little dated, I think it's still important to hear a little bit about what we've done in Wisconsin with Healthy People in schools.

Rose Marie Robertson, American Heart Association

Let's start with our presenters. The first presenter is Rose Marie Robertson, the President of the American Heart Association. I should have told you also that, because I was out of the office yesterday, all of my great detailed notes for my introduction are left at my office in my desk, so I'm going to have to ask the speakers if they can say a little bit about themselves as part of their introduction. Please.

DR. ROBERTSON: I'll take you up on that and begin by telling you a little bit about us and why I am so particularly pleased to be here. I represent the American Heart Association which is a broad grass-roots organization. I think we are here to be a focal point, perhaps to be an example of a voluntary health organization that is very much interested in partnering to help achieve the Healthy People 2010 goals. We are the voluntary health organization that deals with the nation's number one killer, cardiovascular disease, and the nation's number one chronic disabler, stroke.

We are passing around two hand-outs. One is a comparison of our strategic initiatives and the Healthy People 2010 objectives, just so that you can, at your leisure at another point, see how many of our strategic goals and objectives in fact match up quite exactly with the Healthy People 2010 goals. The American Heart Association's mission is to reduce disability and deaths from cardiovascular diseases and stroke. That's been our mission for a long time. That fits really quite perfectly with the objectives of increasing the quality and years of healthy life and eliminating health disparities.

As part of our organizational values and as part of the -- as one of the documents that we use at every meeting associated with the American Heart Association, we discuss the issues of inclusiveness and diversity and try to be certain that we address those issues in all our activities. Because we are a grass-roots organization, we think that we have the opportunity to help make the Leading Health Indicators something that will be more visible to the American public. (Interruption from phone call to Dr. Lee) So, our mission is to reduce disability and deaths from cardiovascular diseases and stroke.

Just to tell you where we are in the country, we are not quite everywhere, but we are almost everywhere. We have 1500 divisions divided up, grouped into, 50 affiliates and about 3,000 staff nationwide. We do, as a business, support the Healthy People goals even in our own activities at the American Heart Association National Center. You can get an apple for 15 cents and skim milk for 15 cents in the vending machines in the cafeteria.

We have a lot of volunteers, including 30,000 volunteers who are science, medical and paramedical personnel within the American Heart Association's councils. So we have, in addition to our lay volunteers and people who work for us across the country, we have a number of people particularly well-positioned to be able to address these goals.

Now, we set for ourselves a very, we thought, stretched goal not quite two years ago, and that was to reduce the impact of coronary heart disease, stroke and risk by 25 percent, initially we said, by the year 2008. As the process for Healthy People 2010 came along, and as we had begun to work on it but hadn't announced our goals yet, it seemed clear to us that the more often the American public hears a message with a single voice, the better our chances are of getting them to pay attention to it. So we brought to our delegate assembly this past summer the concept of changing the date of our goals to match with 2010 goals, and they certainly enthusiastically affirmed that concept.

So repetition is really key, as Randy Wykoff said. We need to be giving this message with one voice, and we need to be saying it over and over and over again, because otherwise, people really don't hear it. My marketing and communications people try to educate me about that, and I think that really is very important.

It is not hard to energize people around this goal, because the concept of viewing something with alarm is really relevant to this. There are more than a million heart attacks every year; there are 750,000 cerebrovascular events; almost a quarter of a million sudden cardiac deaths out of the hospital every year, not to speak of the very large and growing population of people with congestive heart failure who make up a very prominent DRG in hospital admissions.

As we look at our goals, that is, how we get to this 25 percent reduction, it became clear to us, in looking at the big books, that our goals, the goals we had set, align very clearly with many of the 2010 goals and objectives, some in the developmental range, but many in the actual active range.

We decided that we had to focus our activities. We have been around a long time. We think we have done good for the American people, but we've done it in a way that we think is no longer really appropriate to the current environment. That is, we worked very hard to educate and get information out, and we've sort of aimed at the whole population with, if you will, a bit of a shotgun approach. That clearly doesn't necessarily translate into changing behaviors. We hope it will, but in fact we've now committed to focusing our activities in a way that will let us, hopefully, change the behaviors of people in the population, as well as providers.

So we focus on acute care, that is, patients having heart attacks, strokes and sudden cardiac death, and I'll tell you how we've done that in a moment. Those certainly match up with the Healthy People goals related to getting people access to health care and getting them that access quickly, getting them to the hospital quickly with heart attacks and strokes, and getting them treated quickly with sudden cardiac death. In addition, the prevention goals certainly match up with the Healthy People 2010 goals in terms of high blood pressure, cholesterol, obesity and overweight, physical activity, and particularly tobacco.

Our challenge, then, in trying to translate this goal is to say, we are an information organization; we think that's mostly what we do. How do we provide credible cardiovascular disease information and change behavior in every community across the country? Indeed, eliminating disparities is very dear to our hearts as well. We think that the public believes us when we speak. We think that we have great credibility. Our challenge is how to translate that so that it's more broadly heard across the country and so that it really does change behaviors.

Now clearly, even with our four million volunteers, we can't do that alone. We know that we need to do it through strategic partnerships. If there is a theme to my current year as President, it's to develop those strategic partnerships, to invigorate them, to make them real, so that in fact we can leverage the opportunities that we all provide each other. We have had some really very terrific early conversations with the CDC, with the NHLBI. We meet yearly with the NINDS, as well, and have been in

Dr. Wykoff's and Dr. Satcher's office to begin to talk about how we can be more helpful in partnering.

We try to attack these issues in all the places you'll see. What I'll do just for the next few minutes is to tell you what kind of initiatives we have in those areas, so that if those awake ideas for better partnerships, we hope you will come and ask us about them.

We have a strong presence because of our councils in hospitals, medical centers and universities, where we provided last year about $130 million of research in the area of cardiovascular disease and stroke. We think it's at least as important, maybe more important, for us to advocate for increased federal funding for biomedical research. We twice a year go to the Hill to do that, and we engage our council members and our volunteers in doing that. Importantly, that research is not only fundamental cardiovascular science, science looking at very basic mechanisms, but is also behavioral research that helps us translate information to make it effective for patients and across communities.

We produce scientific statements; we publish scientific journals. Those we think are important. They are very highly rated as scientific journals. Circulation Research, Hypertension are very highly rated journals.

We have a program, in addition, in medical schools to allow us to try to change the medical school curriculum, to enhance the medical school curriculum, to specifically address the things that are important in reaching the 2010 objectives. We think that in medical schools we don't do that well enough. We teach physiology and pathophysiology, and we teach individual patient care. We don't do as good a job in getting people engaged in trying to change things in their communities. We think we can help with that.

In addition, we try to tape our scientific statements and guidelines, which we develop in concert with other organizations, often with the American College of Cardiology, often with other cardiovascular organizations. We have some now with the European Society of Cardiology coming along.

We want to make sure that those guidelines are implemented. That is, it's fine to have them, and it's fine to hand them out to physicians. That doesn't make a single thing happen, it seems to us. We hand them out and they sit there on someone's desk, or don't even sit on a desk. So we now are actually moving to programs that will allow us to go into hospitals, work with physicians, provide discharge planning tools, for example, that they get with the guidelines program, to be certain that every patient who comes in with an ischemic heart disease diagnosis goes out having met all the appropriate secondary prevention guidelines. And we provide materials to educate patients.

When we're interacting with people in doctors' offices, and when we're interacting with our partners in health departments or managed care organizations, we both provide professional education. Again, we've realized that changing the behavior of patients is not easy to do; changing the behavior of the public is not easy to do. It may be even harder to change the behavior of physicians. They don't change too easily, either.

So our old professional education modes of sitting people in a room and talking at them isn't very effective. We need to do interactive programs. We are actually revamping our professional education committee and its work to make that education interactive and more effective. And we've produced the guidelines that you see there.

In communities, we do things that are very directly related to a number of the things you've heard here this morning. We are in fact happy and eager to work in coalition with other organizations, with state public health departments, with our partners in the American Lung Association, et cetera, to advocate for clean indoor air laws, to advocate for the appropriate spending of tobacco settlement dollars. In Tennessee, the farmers who are getting them are spending them to water their tobacco in summer. That's not the right place for those dollars to be spent. We were very encouraged to hear how effective the Maryland program had been in buying out tobacco allotments. A 90 percent success rate is almost unbelievable; that just seems so effective. We have to be able to translate that.

That's a population wellness issue for us, in addition.

We want specifically to focus on acute care, that is, being able to save lives of people who have heart attacks, strokes, and sudden cardiac death. We worked hard on the Cardiac Arrest Survival Act last year and continue to work at the state level for public access to defibrillation legislation. We've just released new guidelines providing the scientific base for CPR and heart-saver AED courses for professionals and the public. In my city, one of the companies, which owns 38 malls across the country, has just initiated a program to put defibrillators in their malls in 17 states. We are using that to challenge all the rest of the mall community to do the same thing.

In addition, we recognize that we need to reach people where they want to be reached. One of a Kind and Choose to Move, as you will see in this hand-out, are just two of the many Web-based programs that we have, allowing us to reach people through their computers.

One of a Kind, in particular, is an interactive program, aimed at the individual, that takes information that the individual provides and then gives them ongoing help with nutrition, with weight management, with exercise, with medication adherence, in a very -- what they tell me is the catchword -- granular way. That is, it's based on adult learning theory; it provides specific information according to the stage of interest of the person at the time. I think it's going to be very helpful. We are simply going to watch and see how well it does. So reaching people, the growing population on the Web, is a very important thing, in addition to our previous ordinary print activities.

Then in targeted communities, the 125 largest metropolitan statistical area communities across the country, we are rolling out Operation Heart Beat and Operation Stroke. Operation Heart Beat aims at all the links in the chain of survival from access to 911 and enhanced 911 -- we belong to the National Emergency Numbers Association; we are serving on a committee to help that be spread more widely -- to CPR training, to early access to defibrillation, and early advanced care. This tells communities how to look at those links and make them better in their community. Operation Stroke tries to improve emergency response by teaching the public about the warning signs of stroke. If even our Congressmen don't recognize that the worst headache of their lives is likely to be a stroke, the rest of the population obviously doesn't either.

In schools, we are very much engaged in, particularly, advocacy efforts to keep and strengthen physical education requirements. In our fund-raising activities in schools, we use those to provide educational messages. We want to increase our teaching of CPR in schools, not only because it will help provide an army of people who can do CPR, but because it raises awareness in those children who learn it about cardiovascular disease.

As part of our effort to reach out to a broader part of the community, clearly faith-based initiatives have been important. We have two programs, one called Search Your Heart, and another providing CPR and AED training in churches. We try to work actively with faith-based organizations across the country.

In workplaces, we provide public access defibrillation programs for large businesses. We have a Heart At Work online program for companies that engage with us in preventive activities. Companies that support our American Heart Walk also get year-round advocacy and educational materials for their employees.

Active Web-sites for both the American Heart Association and the American Stroke Association on the Web, as you'll see in this hand-out in more detail. Activities through the telephone: we have an active call center 800 number and the Warmline for stroke family members.

As a last item, we think that we can be helpful in reaching the media. In fact, not only are we there in the media fairly frequently in terms of health news, research findings -- we are very often called about those -- but we are engaging in a large -- for the first time for us -- paid advertising campaign, a call-to-action campaign related to heart attack and stroke and, particularly, the importance of calling 911 for early access. We think that the more we can do those messages together, the better off we'll be in getting those to the public.

Thanks very much.

Mimi Kiser, Interfaith Health Program

MR. NANNIS: Thank you. Our next speaker will be Mimi Kiser from the Inter-Faith Health Program at Emory. Mimi, if you would -- as I mentioned, I apologize for not having your material with me. It's at the office and I didn't go in yesterday, as you know. Will you talk a little bit about what your organization does, as well, at the beginning?

MS. KISER: My name is Mimi Kiser, as Paul said, and I am with the Inter-Faith Health Program, now at Emory University in Atlanta. I've been with the program for seven years. We were at the Carter Center for seven years and just recently, this year, moved to Emory University to be a part of the School of Public Health there. I also will say that, in addition to that, for the last four years, I have worked part-time in a congregation in downtown Atlanta coordinating a parish health ministry, which I have found really has enriched the work that I have done nationally.

My task today is a daunting one, which I'm sure you can appreciate, given the complexity and diversity of the religious organizations in this country. I hope that I do justice to your needs on behalf of the health of all Americans and also, Dr. Satcher, particularly to your wisdom and commitment in this area.

I will begin with some brief background information about the Inter-Faith Health Program, so you will know from whence I speak. In 1984, there was a meeting of public health leaders at the Carter Center to address persistent health disparities in the United States. The religious community was identified as one of the sectors that had the capacity to contribute to closing the gap.

In 1989, under the leadership of Carter and Bill Foege, 300 religious and public health leaders assembled at the Carter Center to discuss the role of the faith community in meeting the challenges in health. A year following this meeting, the Park Ridge Center collaborated with the Carter Center in publishing a document called Healthy People 2000: A Role for America's Religious Communities. I have it here. It's out of print now, but I've hung on to this copy for awhile. Dr. Mason was a part of creating that document and also the meeting in '89 at the Carter Center.

Soon afterward, the Robert Wood Johnson Foundation approached the Center in a conversation, from which emerged the funding for the Inter-Faith Health Program in '92. We began with a best practice information gathering and dissemination strategy, recognizing early on that everything that needed to be done was being done somewhere to align public health and religious assets.

So in subsequent years, our work has evolved to meet the need for expanding these practices to community-level scale and the need for leadership development and formation in this area of practice. Hence, the Faith and Health Consortium, now a network of seven sites in the country and one in South Africa, consisting of partnerships between schools of public health and theology and community-based groups.

I think most of you might have had the opportunity to pick up a newsletter out there. If you haven't, there are plenty out there -- Faith and Health, that has our Web-site on it and also a listserv that I would highly recommend for any networks of practitioners that you are associated with as a wonderful learning environment for practitioners in both fields who are sharing practices and what they are doing in the field.

For this discussion, I think it's important to clarify what we mean by the faith community. I think probably everybody comes to this conversation having a certain idea about what that is. There are at least five elements relevant, we feel, to health improvement efforts.

First, the approximately 300,000 to 400,000 congregations in the United States. Realistically speaking, we believe that about 10 percent are open to, or actively engaged in, community health improvement activities. Many but not all congregations are part of large organizational infrastructures called connectional systems, or the religious word is ecclesiastical systems. You often hear most of them referred to as denominations. These vary tremendously in capacity and their infrastructure. Most have limited influence in communication at the local level. Many now have health programs, however.

Associated in different ways to these structures are the academic institutions, with the responsibility for educating new and practicing religious leaders. Found generally in local and regional areas are ecumenical and inter-faith structures that represent congregations and leaders who see the need for collaboration and are open to accomplishing their mission in partnership with others. This is a sort of key player in communities for large-scale community health improvement partnerships.

Marshall Kreuter at the CDC recently discovered this kind of network in a community as being an indicator of the kind of social capital that's necessary for community health improvement planning activities. He looked at different PATCH communities, where they had tried to implement PATCH, and looked at elements of social capital. One of the ones that he found was a ministerial alliance.

A new faith community asset is conversion foundations that have formed as the result of sales or mergers of a religious hospital that are now assets entrusted to community health activities and responsibilities still with a religious mission. There's a booklet that was produced from a meeting that was sponsored by the Carter Center and our program in the CDC called Strong Partners -- the Council members have it there -- that says more about the potential of this asset.

There are a host of social service, education and health organizations currently owned or at least directed by religious missions. Most important are the 156,000 million people of faith who attend worship regularly. They are influenced by that environment, by their worship environment, and particularly if they are part of that 10 percent of the heavy-lifter congregations in communities that are formed to, in religious language, reduce suffering and seek wholeness for others out in the world, those that might be actively engaged in public health-type activities.

Some brief comments on the context for this work. Where do we find ourselves now in this faith and health arena nationally?

The engagement of faith communities in health improvement has been likened to a social change movement that has four main aspects. Numerous studies now -- there's one in the paper today, a medical researcher demonstrating the association between spirituality or religiosity and disease response outcomes. Yet rarely have these studies examined the full potential and the relationship beyond the individual in a population-based or community health systems perspective, or encompassed the effect of prevention on illness. It's usually recovery from illness, generally.

We are seeing more religious structures in communities for the explicit purpose of improving and contributing to the health of those communities. Then, brought into the limelight by the campaigns, is the broad-scale realignment of social responsibilities and a new understanding of enduring accountability for community structures.

Last, is the vitality of congregational life. I think we underestimate that in the social infrastructure of our communities. It represents the most viable voluntary association in communities in America, places where people belong; they choose to belong, where meaning is framed in their life. A lot of leaders in communities are formed out of their social roles and relationships in those congregational settings.

Now, what are the trends relevant to accomplishing health promotion and disease prevention objectives? One of the notables and most recent is parish nursing. These are non-clinical roles held mostly by non-paid RN's, although in the last five years, hospitals are increasingly on-board in developing these initiatives. So now there are more paid positions in this practice in congregations. This is a growing field, now with standards of practice recognized by the American Nurses Association and credentialed certification processes in some graduate nursing schools.

A broader, less defined domain is health ministering. This includes parish nurses, but also includes a diverse array of professions and lay persons in congregations who do health education and health promotion. Both of these tend to focus a little more internally in a congregation as a rule, but many, and more so now, are engaged in community outreach activities and partnerships.

There's a grass-roots national health ministries association that represents a network of these practitioners around the country. It's grass-roots, as some of these national volunteer organizations are, with now a little over a thousand members.

You may be aware of a long list of government-funded programs that now, under RFPs, require engagement with the faith community. We get calls from these people a lot. They include, but may not be limited to -- you may know of more than I do -- cardiovascular disease, physical activity, diabetes, substance abuse, cancer prevention and early detection, HIV/AIDS, violence prevention, Reach 2010 and access to health care, to name a few.

In our academic network, the Faith and Health Consortium and other sites, there are partnerships forming between schools of public health and seminaries, and community partners. They are offering interdisciplinary courses, working with community partners as practice sites for students and faculty, and planning interdisciplinary courses and research.

The Inter-Faith Health Program over the years, the last seven years, has developed relationships with, and worked in, the leadership and provided technical assistance capacity to several communities around the country which form community-scale collaboratives that typically, at a minimum, involve public health agencies, health systems and networks of faith-based organizations. There may be other partners collaborating in that. Then, in the sites where there is an overlap with the Faith and Health Consortium site, there will be academic partners in the collaborative.

Worth mentioning, I think, is that for more than 25 years, the Robert Wood Johnson Foundation has been supporting the development and enhancement of congregations' natural care-giving roles in communities with their Faith in Action program. This has been a substantial financial investment that they've made, recognizing the critical social infrastructure that the faith community offers to older adults, to those with chronic illnesses and disabilities, who are home-bound or have limited access to community support services.

I will conclude with some recommendations and issues for you to consider. First, I will echo comments made in the morning several times, particularly by Ms. O'Keefe from NACCHO.

The diversity of the faith community and their tenuous national infrastructures -- I hope I haven't offended anybody by that -- warrant a local approach. I want to emphasize that. One strategy would be to work through local public health practitioners. The place of emphasis should be on leaders in communities. This means religious and public health leaders and their partnership-building skills -- so that role of partnership-building capacity of leaders in communities.

There is now an endless array of tools for successful collaborations and partnerships. You could fill three rows of shelves with big binders of tool-kits of partnership-building and community assessment planning that involves bringing in key partners. So we don't need to create any more of those. But yet, not enough of that has really been disseminated in real deep learning and practice that is evident yet in the practice at the local level, I believe, in partnership building.

Leaders form bridges for communication and for building support across these different diverse sectors. They are a very important pathway for understanding and communication and building the possibilities for engagement in shared missions. One strategy here would be to work on skill-building with the now well-established network of local, regional, and national public health leadership institutes. That is a venue that has some potential for where there could be some deeper learning for partnership-building and relating across these two particular sectors.

Regarding framing, most of the language of the health objectives is very medical and not meaningful to the faith community. Perhaps another document -- I'm not sure about that -- but perhaps another document is needed, similar to the one produced by the Carter Center for the 2000 objectives. For this one, I would recommend involving more religious leaders in the framing and writing so that it would be meaningful to a broad religious constituency.

Most of the conversation around involving faith communities I hear very often tends to be about using the faith community. Neither public health nor, really, the faith community itself fully recognizes and understands the full assets and contributions of the faith community to creating health. This, I believe, is an untapped and important area for scholarly analysis and research to look at the full assets that congregations and faith-based organizations bring, particularly as the definition of health is broadening to include social determinants in looking at community capacity and social capital.

The faith community and their understanding of justice will be critical partners to you in eliminating disparities. That is one sector in the community that will be critical to your work to accomplish that.

Lastly, I would avoid support for any new initiatives. My recommendation is to track the current work, because there is a lot being done, and it's being done with currently-funded initiatives throughout the country in a lot of the disease category areas I mentioned that are natural linkages to the Healthy People 2010 objectives. So across all the infrastructures and organizations that are currently funding those, there are many partnerships that are happening where public health programs are successfully engaging the faith community. But the faith community does not have the capacity of some other organizations to engage fully in measuring and collecting data and that sort of thing. So the work that they are contributing to health improvement in the community is dependent on you and your constituents for the tracking and those kinds of resources.

That is all I have to share with you. I'd be glad to answer questions.

Paul Nannis/HRSA (Moderator)

MR. NANNIS: Thank you, Rose Marie and Mimi. We can appreciate the fact that Michael is not here, given the death in his family. But at Dr. Satcher's request, I thought I would say a couple of words about the relationship between Healthy People and the schools in Wisconsin.

As some of you know, I was Health Commissioner in Wisconsin for nearly 10 years and had been involved before that in both maternal and child health and primary care associations. I was also pleased to co-chair the Wisconsin Healthy People 2000 roll-out plan as Wisconsin tried to take the federal plan and roll that out to Wisconsin -- too many years ago now.

It was a very deliberate, bipartisan effort. I say that deliberately, because the Department of Instruction is an office of the Governor, but the schools are controlled by locally-elected school boards. It was very important to us, as we put together the coalition that was going to take the federal document and make it resonate at the state and local level -- it was very important to us that we have representatives of both, that we had the Department of Public Instruction, which was a political office, as well as the local boards of health in their political capacity in local communities.

All I will say about that is that we were surprised at how important it was to have members of both on the planning committee. There were those school districts that were at the point of saying, we can't afford school services any more, school nursing services anymore, school recreational services anymore. But through the process of engaging with the public health professionals, the other community members, the faith community, the others that were part of this very large planning process, most of the school boards, with the support of the Wisconsin Department of Instruction, maintained their strength in their programs. They understood Healthy People 2000; they rolled out programs that were tied to Healthy People 2000; and they participated in the coalitions and the activities that we organized in different places around Wisconsin related to the roll-out of 2000.

Now my information is a little dated. I've been gone, as most of you know, for two and a half years. But I do know that the Wisconsin Department of Instruction has done two things since, looking at 2010.

One is that they have joined in the collaboration with CDC, specifically on identifying those issues that could be pulled out and are appropriate for school-based activities for kids related to CDC-supported funding. They're working with HRSA in many ways, but particularly on those grant programs that we use or that we fund. They have tied the Kellogg-RWJ Turning Point initiative, as it rolls forward -- they are tying the outcomes and what I call the second generation of Turning Point -- tying those outcomes to as many of the 2010 outcomes as they can possibly align.

I think that's tremendous progress for Wisconsin. It just states to us the importance -- in retrospect, how smart we were -- in involving both the Department of Instruction and the local school boards, as well as teachers and community and residents. I am sure that's happening elsewhere. I wish Michael were here to talk about more of it, but I can just say from my experience in Wisconsin, it was a great experience and we've learned a lot. It does seem to roll forward.

Questions for the speakers?

DR. SATCHER: This is to Rose Marie. I am really interested in your initiative relative to medical education, because we have not done well in that arena. As I go around and speak to medical students, generally, they don't know what you're talking about when you mention Healthy People. I mentioned this to AAMC, and I know AAMC is trying to work with us, but it's been very hard to get this kind of initiative to impact upon the curricula for medical schools.

DR. ROBERTSON: It seems to us that it's going to take not just devising curricula that would be appropriate, but it's actually going to take local champions in each medical center to make that happen. We are hoping to utilize our council members, council leadership in particular, to try to make that happen in medical schools.

DR. SATCHER: Well, if there is something we can do in partnership there, I would certainly be interested.

MS. BRASLOW: Judy Braslow from SAMHSA. I have a question for you also, and it's putting on a previous hat that I wore when I was at HRSA planning the organ transplant program. It struck me that, with all of your initiatives, the best modality for people with heart disease at a certain stage is a heart transplant. There's an enormous organ shortage. The waiting list is probably three years now for a heart transplant. So I wonder what the AHA is doing at the local level and coordinating with the national organizations working in this area to help with organ donation.

DR. ROBERTSON: That is a very good question -- and probably not much. I think our members, particularly in our Council on Cardiovascular Surgery and our members in clinical cardiology who have a very active heart failure group, they work on that activity in their communities, insofar as any of them do do that. But we don't have a specific initiative directed at that.

MS. BRASLOW: I would suggest that there's a -- just looking at your initiative with local chapters and local organ procurement organizations and the medical schools that Dr. Satcher just alluded to, as well as the national program run out of HRSA, there's enormous opportunity for helping with that.

DR. ROBERTSON: A number of years ago, before Bill Frist was a Senator, he was a heart transplant surgeon. Kids on the Block put together a program for schools.

MS. BRASLOW: That's out of Tennessee?

DR. ROBERTSON: Yeah, absolutely spectacular. I watched that program being given to third, fourth and fifth grade kids, who walked out saying, I want to sign an organ donor card. Kids could deal with information much more easily than adults could. They could ask the kind of gory questions that adults are often afraid or find very difficult to ask. Education at that level, I think, is tremendously important. So that kind of program around the country would make a huge difference.

DR. MASON: I wanted to ask Mimi -- you mentioned that there are over 168 or 160 million adherents to faith-based organizations and, I think, less than 50 percent of those organizations have some sort of a health program activity. You don't have to own a hospital or operate a hospital, because for so many of the things that we're focusing on, half of the targets are behavioral.

What can Healthy People 2010 do to get more involvement in Healthy People? If that could go from 25 percent of those faith-based organizations to 50 or 75 or 80 -- you know they have such an appeal to the members of the faith-based organizations. Is there anything that can be done to bring more into some sort of activity related to Healthy People?

MS. KISER: I think it really has to be a multi-pronged approach. I mentioned several things that would get at it from different directions. I think, if some academic leaders would be involved with religious leaders in developing something that would make meaning and provide some credibility to the religious community: This makes sense to us because -- . So I think, some kind of document to lend credibility.

But then, I really think that the rubber meets the road in communities, where partnerships are formed and people can, through relationships across health and faith sectors, discover how that's meaningful for them in their congregation and communities. I think it's very contextual. I think it's really -- there is no easy infrastructure.

The CDC is putting some money into -- I've watched over the years -- the Congress of National Black Churches to help build enough of an infrastructure in the regional health councils. For me to watch that at the community level -- it's really hard to feel that. So I think the most viable avenue is going through the most dependable infrastructure -- which you all have access to, which is the public health system -- and enhance their ability to communicate and partner and build the interest locally.

DR. SATCHER: When it comes to this whole area of eliminating disparities, I think this is a critical area. As I view it, and I could be wrong, the most viable institution in the black community today is the church. The growth of the church -- just look at Atlanta and the way the church has grown: new buildings of all kinds, where they have graduations now because it's the biggest building in the community.

If we could get the church more involved in public health and Healthy People 2010, it would certainly help in our efforts to eliminate disparities. So many of the people that we need to get to, their only obvious allegiance seems to be to the church. So I think we have got to find a way. The thing we did with the Congress of National Black Churches was certainly critical for the immunization effort, but they could do much more -- you're right about that -- in terms of what they already have, in terms of infrastructure. I'm saying, we're very interested in working with you, partnering.

MS. KISER: I think the other tie-in in the need to connect with local infrastructures is their ability to do any kind of meaningful documentation in support of tracking. It would be critical that they be linked closely in a partnership environment. You can't expect the religious community to really do public health in that role, capacity.

DR. MASON: Maybe on the infrastructure development at the community level, there ought to be part of that linkage with churches and faith-based organizations as a major item. I think you're right. If we're going to get at those disparities, this is one of the routes that ought to be taken. I'm not sure that we're taking it as well as we could.

DR. SATCHER: We're going to look at that. Mimi was saying that it would bring new credibility. I think that's a very important point, and I know it requires more research. When I was speaking in New Hampshire to the New Hampshire Medical Association, one guy had read my article in Guideposts. So his question was, what is the role of spirituality in promoting mental health? Well, I don't know, because we haven't done that work.

There are a lot of questions like that it would be great to have answers to, but you can't say you have an answer that you don't have. So we have to do the research.

MS. BRASLOW: Related to that, Dr. Satcher, I've been involved with a national Jewish organization of a thousand Reform congregations that is interested in developing an initiative for all Reform Jewish congregations on mental health. Rabbis are dealing with it every day of the week.

The big question in my experience, having worked with this organization, is -- they have no idea how to access our infrastructure, what agencies within the federal government. I was contacted only because I'm on a mailing list and know this guy. He knows I'm at SAMHSA and sees mental health in the title, but doesn't have a clue what's available in the federal infrastructure to help with any of their social concerns, be it mental health, substance abuse, organ donation, cancer treatment, whatever. They don't have any idea. So it strikes me that we could be doing a lot in educating the national organizations on how we function, how we work, what the resources are.

MS. KISER: There are a couple of denominations that actually exhibit at APHA every year. It would be interesting if the reverse was true, if public health groups had exhibits at some of their large gatherings.

DR. WYKOFF: That raises a question that we have talked about several times. Excuse my ignorance; this may be something that everybody else knows except me. Is there a time and place where multiple religious groups come together in a single location, so that we could access multiple groups at one time? Does that make any sense? I don't have my glasses on. I can't tell what sort of reaction I'm getting. Oh, worse than I thought.

MS. KISER: I think there are certain ones. There is a National Council of Churches, which tend to be more mainline denominations that are already on board. So the most organized in a large-scale way could come together. There's the Congress of National Black Churches. I think there has already been quite a bit of effort in doing that, but not as much as you would anticipate. I can't think of any, other than that. That's probably the largest religious gathering of populations that need more access to this information.

DR. SATCHER: I think the message is clear, though. I think we need a strategy for working with faith-based organizations within ODPHP. We'll move to develop that.

Partnership to Eliminate Health Disparities

This is a pretty good segue, because you mentioned the National Council of Churches. I guess Andy Young is now the head of the National Council of Churches and is one of the people who have agreed to work with us on eliminating disparities. The next topic on the agenda and our last topic for today is the whole issue of the partnership between our Department of Health and Human Services and the American Public Health Association, the partnership which we announced a few months ago with Dr. Mohammad Akhter and the Board of the American Public Health Association.

It's a tremendous story, just in terms of how we got to this point. But I think the story of where we're going together is even greater. So I'd like to turn it over now to Dr. Mohammad Akhter, the Executive Director of the American Public Health Association, to speak about the Call to the Nation to Eliminate Racial and Ethnic Disparities.

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